Ana Pilar Betrán: seeking the optimum use of caesarean section

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What is the “correct” rate of deliveries in which birth should be by caesarean section? There is no clear-cut answer to the question, and the success of recommendations intended to raise or lower an existing caesarean section rate is not easily judged by reference to a predetermined numerical goal. As one of the key contributors to this issue’s Lancet Series on optimising the use of caesarean section, Ana Pilar Betrán of WHO’s Department of Reproductive Health and Research finds herself in territory characterised by uncertainty. Given the mindset that first attracted her to science, her focus on caesarean section might seem paradoxical.

She had been drawn to science while at school; later, as a student at the University of Zaragoza in Spain, she chose to study chemistry, specialising in biochemistry. She loved the predictability of the chemistry lab, she says. “When you put acid on a base you always get a salt and water. It’s reliable, it has certainty, and as a young person I always liked that.” Her chemistry course complete, she switched to medicine. Why? “I began to feel that if I continued [in biochemistry] I would miss the human factor. It’s enriching. I felt I needed it to be happy in life.” Human factors are certainly at the core of what she’s currently working on: the development and implementation of policy on caesarean section. “I am more and more engaged in implementation research, which is exactly the opposite [of predictable]…How human beings react, how organisations react, how different health systems react to the same intervention is impossible to foresee.”

Caesarean section—the most common surgery in many countries around the world—is a procedure that can save women’s and babies’ lives when complications occur during pregnancy or birth. However, caesarean section use for non-medically indicated reasons is a cause for concern because the procedure is associated with considerable short-term and long-term effects and health-care costs. Caesarean section use has increased over the past 30 years in excess of the 10–15% of births considered optimal, and without significant maternal or perinatal benefits. A three-part Lancet Series on Optimising Caesarean Section Use reviews the global epidemiology and disparities in caesarean section use, as well as the health effects for women and children, and lays out evidence-based interventions and actions to reduce unnecessary caesarean sections.

Access the 1st paper of the Lancet series – Global epidemiology of use of and disparities in caesarean sections

Access the 2nd paper of the Lancet Series – Short-term and long-term effects of caesarean section on the health of women and children

Access the 3rd paper of the Lancet Series – Interventions to reduce unnecessary caesarean sections in healthy women and babies

Access the 1st Comments paper about the series – FIGO position paper: how to stop the caesarean section epidemic

Access the 2nd Comments paper about the series – Appropriate use of caesarean section globally requires a different approach

Access the 3rd Comments paper about the series – Strategic measures to reduce the caesarean section rate in Brazil

Access the Editorial paper about the series – Stemming the global caesarean section epidemic

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